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Senior Workers Compensation Claims Adjuster

4 months ago

Las Vegas, United States UnitedHealth Group Full time

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM

Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self-Directed? These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Under minimal supervision, the Workers Compensation Claims Adjuster, reviews, analyzes, investigates, makes compensability decisions, set appropriate reserves, and approves the release of benefit payments up to authorized levels on initial, continued, and reopened claims. 

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm PST. It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at S Pearl Street, Las Vegas, NV .

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

Primary Responsibilities: 

Evaluates new and on-going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence. Investigates questionable claims. Determines needs for additional medical information. Determine appropriate benefit calculations and payments. Performs reviews to verify initial and continued existence of a disabling condition. Responds to telephone and written inquiries from claimants, attorneys, physicians and policyholders within statutory requirements. Identifies and forwards claims to specialized internal and external resources in areas such as medical exams, rehabilitation, investigations, subrogation and subsequent injury. Track time frames as mandated by statute and regulation. Respond to correspondence to include litigation compliance with decisions & orders. This level is responsible for independently reviewing simple to complex claims for adjudication purposes. Refers more complex claims to higher levels for review and direction. This level is responsible for administering complex including catastrophic and death claims Claims handle will include claims in access and permanent total disabilitySubmit for COLA reimbursement and SIF

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

High School Diploma / GED OR equivalent experienceMust be 18 years or olderNevada Staff Adjuster License 5+ years experience processing and adjudicating simple to complex claims 1+ years experience with catastrophic claimsKnowledge of Excess Reporting, Subsequent Injury and Subrogation ClaimsAdvanced knowledge of fundamental concepts, practices and procedures of case law and state Worker’s Compensation laws, subrogation, reserve setting, and litigation managementMicrosoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), Microsoft Outlook(Create emails and send emails)Ability to work our normal business hours of 8:00am – 5:00pm PST. It may be necessary, given the business need, to work occasional overtime or weekends.

Soft Skills:

Ability to multi-task and understand multiple products and multiple levels of benefits within each product Excellent oral and written communication skills Excellent analytical and problem-solving skills 

Physical and Work Environment: 

Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse Office environment

Nevada Residents Only: The annual range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $48, - $94, per year. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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